What does life
expectancy at birth mean? [The number of years a newborn infant
would live if prevailing patterns of mortality at the time of birth
were to stay the same.]

What does it
tell you about a country? [High life expectancy at birth suggests
that people have access to the things that contribute to a long, healthy
life such as nutritious food, safe water, sanitation, health care
and education.]

On the basis
of your experience, what do people need to maintain health? [immunizations,
clean drinking water, adequate and nutritious food, hygienic living
conditions and health care]

On the basis
of your experience, what do people need when they are ill? [medicine,
doctors, nurses, hospitals, pharmacies, nutritious food, clean water]

Based on the
above answers, what can you infer about conditions in a country with
a low rate of life expectancy at birth? [The things identified
in c and d are lacking.]

2. Read the Text
and the glossary definitions of infant mortality and under-five mortality,
and answer the following questions:

What do infant
mortality rates measure? What do under-five mortality rates measure?
[The infant mortality rate measures the number of infants who die
before reaching the age of one, per 1000 births in one year. The under-five
mortality rate is the probability that a newborn baby will die before
it reaches the age of five.]

Why do low-income
countries have lower rates of infant and under-five mortality? [They
are unable to prevent malnutrition in mothers and children, and to
prevent or treat infectious diseases.]

Why is infancy
and childhood such an important period in determining a country's
life expectancy at birth? [Children who survive their fifth year
have a much better chance of living to adulthood and old age. Much
of the increase in life expectancy is due to improvement in health
care and nutrition for children and infants.]

3. Life expectancy
statistics do not tell how long a person will actually live,
but rather, how long a person, on average is likely to live.
Changes in income, health conditions, and education are constantly occurring
and will affect life in a country. Read the list below and decide whether
each situation is likely to increase or reduce life expectancy at birth,
or have little or no effect in either direction. Explain your decision.

A severe drought
causes a famine. [Reduce: A prolonged food shortage would lead
to an increase in deaths, especially among children.]

A new health
clinic opens and more children are inoculated against childhood diseases.
[Increase: Vaccines for childhood diseases such as diphtheria,
pertussis (whooping cough), tetanus, measles, poliomyelitis can prevent
illnesses that cause death or weaken children resistance to other
illnesses.]

The government
declares a new national holiday for all workers. [No effect: This
would not directly affect mortality rates.]

Village women
attend classes to learn more about good nutrition and hygiene. [Increase:
Mothers' knowledge of nutritious food, health, hygene, safe water
and sanitation is important especially for the survival of children.]

Traveling nurses
monitor the growth of infants and provide extra food to those who
are not thriving. [Increase: Having sufficient nutritious food
would strengthen children's resistance to diseases and illnesses.]

Men from a low-income
neighborhood lose their jobs when the factory in which they work closes.
[Reduce: Loss of income can affect peoples' ability to buy nutritious
food or pay for medical care and medicine. Also, people who face long-term
unemployment often are subject to health problems such as stress-related
illnesses, drug and alcohol abuse, or suicide. On a large scale these
problems may contribute to a higher adult mortality rate, and therefore
lower life expectancy.]

4. Which of the
following government actions would best respond to the problems listed
below: (building pit toilets, using posters and handouts to transmit
information, testing women for iron deficiency, requiring immunizations
for all male and female children).

Doctors note
an alarming increase in HIV (the virus that causes AIDS) in pregnant
women. [using posters and handouts to transmit information]

Problem: An increase
in measles and polio occurs among children. [requiring immunizations
for all children]

5. Study the table
and answer and discuss at least three of the following questions:

Level
of GNP per Capita (low, middle, high)

Low
birthweight babies as a percent of all births, 1992-1998

Percent
of adult males who smoke, 1985-1998

Percent
of adults infected with HIV, 1997

Percent
of children under 12 months with immunization for measles, 1995-1998

Argentina

Middle

7

40

.69

98

Togo

Low

20

65

8.52

38

United
States

High

8

28

.76

89

Portugal

High

5

38

.69

99

Bangladesh

Low

50

60

.03

97

Vietnam

Low

17

73

.22

96

Moracco

Middle

4

40

.03

92

According to
the Text, surviving the first five years
is the most important factor in determining life expectancy at birth
in a country. Based on that statement, which of the countries in the
chart is most likely to have low life expectancy at birth? [Togo,
Bangladesh, Vietnam] Why? [Low birthweight is a significant
factor in causing high child mortality rates. Children who are underweight
at birth may not be strong enough to fight off common childhood illnesses.]

In what country
might life expectancy at birth actually decline? [Togo] Why?
[Togo has a high rate of HIV infection and a high percent of adults
who smoke, both factors in adult mortality. Its high percent of low
birthweight babies also contributes to its child mortality rate. Togo's
life expectancy at birth was 49 in 1998, the same as in 1980.]

Which countries
might experience an increase in its adult mortality rate in two or
three decades? [All the countries shown in the table could experience
higher adult mortality if the percent of adults who smoke remain the
same. Togo, Bangladesh, and Vietnam face a much high rate of adult
mortality than the others.] Why? [Smoking-related diseases
such as lung cancer usually take 20 to 30 years to develop. Furthermore,
the percent of adults who smoke in high-income countries has been
declining, while the percent that smoke in middle- and low-income
countries has been on the rise since the 1970s.]

What evidence
in the table would suggest that education could bring improvement
in these public health problems? [The lower figures for Portugal
and the United States suggest that high-income countries with widespread
literacy, schools, and media can more effectively encourage people
not to start smoking or to stop smoking. In countries in which AIDS
is a serious threat such as in Argentina, the United States, and Portugal,
literacy, schools, and the media have played a major role in prevention
campaigns] What other factors might also be required for further
improvement in these statistics? [Having sufficient money to provide
immunization, literacy, educational campaigns, and nutritious food,
and having a government that is responsive to its people's need for
better living conditions are essential ingredients.]

Why might it
be more difficult for a low-income country like Togo to educate its
people about the dangers of AIDS and smoking than for high-income
countries like Portugal or the United States? [Togo's illiteracy
rate is high: for young people aged 15 to 24 in 1998, it was 14 percent
for males and 44 percent for females; Portugal's illiteracy rate was
0 percent for both boys and girls, aged 15 to 24 in 1998. Furthermore,
more investment in education is difficult because Togo does not produce
enough. Togo's GNP per capita was $330 in 1998; the GNP per capita
for the United States was $29,240.]

What is your
hypothesis for why it appears to be easier for countries to achieve
high levels of measles immunizations than to reduce the percentage
of low birthweight babies? [The problem of low birthweight babies
is more complex, involving the supply of nutritious food, the health
and care of pregnant mothers, knowledge and availability of family
planning, and the education of women and girls. Those problems in
turn are often influenced by the availability of money and by the
attitudes and values within communities. Immunization may also be
influenced by money and values, but otherwise, are relatively easy
to obtain and carryout. Immunization does not require long-term commitment
to individual families. Little preparation or follow-up is needed.]

How might some
high-income countries contribute to the high levels of smoking in
low- and middle-income countries? [Stockholders in high-income
countries own shares of many tobacco companies. Because of free trade
policies adopted by most countries, they can sell their products in
low- and middle-income countries.]

How might some
high-income countries contribute to the high levels of immunization
for measles in many low- and middle-income countries? [Stockholders
in high-income countries own shares of many drug companies. Because
of the free trade policies that most countries have adopted, they
can sell their products in low- and middle-income countries.]

Countries usually
base their decisions and policies on the priorities of their governments
and people. To what extent does the evidence in the chart, suggest
the top public health priority of each country? [Answers will vary.
Students should recognize that in Togo, all of these problems may
be top priorities. Because Togo is a poor country, the money to invest
in starting or expanding programs is lacking. Positive figures also
may not reveal priorities. Low HIV infection rates, for example, may
reflect the influence of culture, religion or location, rather than
specific public health or educational programs.] Hypothesize about
other reasons for the variation in the statistics. [Answers will
vary. Although having sufficient money to invest in programs is always
important, political or cultural factors may be as significant. In
the United States, a high-income country where individual responsibility
is an important belief, the percent of low birthweight babies is higher
than in middle-income countries and the percent of children
immunized against measles is lower. The history of individual countries
also plays a role. Because of long experience with cigarette smoking,
Portugal and the United States faced an epidemic of smoking related
diseases much earlier-- by the middle of the twentieth century. They
have had much more time to plan educational programs. Togo and Bangladesh
gained political independence and control of their futures much more
recently than the other countries shown here. Since educational and
health care facilities and programs take many years to develop, new
nations may take longer to implement programs.]

6. Based on the
Text and your own knowledge, argue for or against
the following statement: Life expectancy at birth is a useful indicator
for measuring Sustainable Development. [Answers will vary.]